VA-BC Patient Evaluation & Care Coordination 4 — Questions and Answers
Question 1: A patient is scheduled for a PICC insertion but reports a previous reaction to latex gloves during a prior procedure. Which pre-insertion action is mandatory?
- Document the allergy and proceed with standard latex gloves
- Premedicate with diphenhydramine 30 minutes before insertion
- Ensure a latex-free environment and use non-latex supplies for the entire procedure (Correct answer)
- Delay the procedure until allergy testing is completed
Correct answer: Ensure a latex-free environment and use non-latex supplies for the entire procedure
A documented latex allergy requires a completely latex-free environment to prevent anaphylaxis; all gloves, equipment, and supplies must be latex-free prior to proceeding.
Question 2: During vascular access team rounding, which patient would be the highest priority for evaluation of vascular access needs?
- A patient with a functioning PIV who has 2 more days of IV antibiotics remaining
- A patient on TPN with a PICC whose dressing is due for routine change tomorrow
- A patient with end-stage renal disease and no current access who requires urgent IV medications (Correct answer)
- A patient whose port was accessed yesterday for chemotherapy and is currently infusing without issues
Correct answer: A patient with end-stage renal disease and no current access who requires urgent IV medications
A patient with ESRD, no access, and urgent IV medication needs represents an immediate safety risk requiring prioritized vascular access evaluation and device placement.
Question 3: A nurse assessing a patient for PICC placement notes the patient is agitated and unable to cooperate with positioning. What is the most appropriate next step?
- Proceed with the procedure using two nurses to hold the patient still
- Document inability to assess and defer the procedure
- Collaborate with the provider to address agitation before insertion, considering sedation or anxiolytic medication (Correct answer)
- Place a peripheral IV instead and reassess in 24 hours
Correct answer: Collaborate with the provider to address agitation before insertion, considering sedation or anxiolytic medication
Patient cooperation is essential for safe PICC insertion; uncontrolled agitation increases the risk of movement-related complications, and addressing it with appropriate sedation is required before proceeding.
Question 4: Which laboratory value, if abnormal, should be reported to the provider before performing a tunneled CVC insertion?
- Serum albumin of 3.0 g/dL
- INR of 3.2 (Correct answer)
- Hemoglobin of 10.5 g/dL
- Serum sodium of 133 mEq/L
Correct answer: INR of 3.2
An INR of 3.2 indicates significant coagulopathy that markedly increases bleeding risk during tunneled CVC insertion, requiring provider notification and correction before proceeding.
Question 5: A vascular access nurse is educating a patient about their newly placed implanted port. Which statement by the patient indicates a need for further teaching?
- 'I should call if I notice swelling or redness at the port site.'
- 'I can go swimming in a pool 48 hours after my port is accessed.' (Correct answer)
- 'I need to have my port flushed every 4 weeks when it is not in use.'
- 'I should tell all my healthcare providers that I have a port.'
Correct answer: 'I can go swimming in a pool 48 hours after my port is accessed.'
Swimming in a pool with an accessed port is contraindicated due to infection risk; the patient should avoid submerging the accessed site until the needle is removed and the site is fully healed.
Question 6: When reviewing a care plan for a patient with a PICC receiving vesicant chemotherapy, the vascular access nurse should ensure which safeguard is in place?
- Verify tip location via chest X-ray or fluoroscopy confirmation before initiating vesicant infusion (Correct answer)
- Use the smallest lumen available for vesicant administration
- Apply a warm compress to the insertion site during infusion
- Flush with saline every 8 hours during vesicant infusion
Correct answer: Verify tip location via chest X-ray or fluoroscopy confirmation before initiating vesicant infusion
Radiographic confirmation of correct catheter tip position at the cavoatrial junction is mandatory before administering vesicant agents to prevent catastrophic extravasation into surrounding tissue.
Question 7: A patient with obesity (BMI 42) requires peripheral IV access. Ultrasound reveals the basilic vein at a depth of 1.5 cm with a diameter of 5 mm. What is the appropriate catheter selection?
- 20-gauge, 1-inch catheter
- 20-gauge, 1.88-inch or longer catheter to ensure adequate intravascular length (Correct answer)
- 14-gauge, 1-inch catheter for adequate flow
- 18-gauge, 1-inch catheter as standard for all patients
Correct answer: 20-gauge, 1.88-inch or longer catheter to ensure adequate intravascular length
When vein depth exceeds 0.5 cm, a longer catheter (≥1.88 inches) is needed to ensure sufficient intravascular dwell length and prevent dislodgement in patients with obesity.
VA-BC Patient Evaluation & Care Coordination 4
A patient is scheduled for a PICC insertion but reports a previous reaction to latex gloves during a prior procedure.
Which pre-insertion action is mandatory?